A community kickoff is held Oct. 1 to sign up people on the federal exchange at Jefferson Street Missionary Baptist Church in Nashville. / Samuel M. Simpkins / File / The Tennessean

Written by

Shelley DuBois

The Tennessean

What you pay

Here are the percentages of health care costs you pay for each type of plan:

Bronze plan: 40% Silver plan: 30% Gold plan: 20% Platinum plan: 10%

Customers pay their portion of their own health care costs in the form of deductibles and copayments, or co-insurance.

In general, the more you are willing and able to pay each time for health care service or a prescription, the lower your premium. A premium is your monthly payment to have insurance.

More

ADVERTISEMENT

The state’s largest insurer, Blue Cross Blue Shield of Tennessee, has collected data about the newly insured under the Affordable Care Act that offer some early surprises.

Preliminary numbers suggest that people buying BCBS policies on the federal exchange are purchasing health care in a different way than hospitals and other providers predicted.

The providers’ main worry was this: An influx of new people would buy insurance mainly based on cost. Generally, the cheapest plans have higher deductibles. Until members met their deductibles, they’d see expensive bills that they’d have to pay out of pocket, which would surprise them, especially because they were new to insurance.

People would then fail to pay those bills, and hospitals would have to eat the cost.

But there’s evidence that something else is happening, based on data that are admittedly early, from BCBS of Tennessee.

It turns out that 35 percent of BCBS of Tennessee members who have enrolled via the federal exchange have chosen plans with no deductible, which typically means a higher monthly payment. And people who have purchased plans with deductibles have tended to buy plans with low ones. In fact, a greater proportion of people who enrolled on the federal marketplace have richer coverage than those who enroll in the company’s individual plans.

The richness of a plan is marked by metals — generally bronze plans are the cheapest and leanest, while platinum policies are top-of-the-line coverage.

“So far, only about 20 percent of people have chosen a bronze plan and the vast majority are choosing silver plans,” said Kelly Paulk, product director for BCBS of Tennessee, regarding Tennesseans who have enrolled in the exchange. “And another 25 percent have chosen either a gold or platinum plan.”

The company has not yet revealed, however, how many people have enrolled in its plans overall — it is waiting for better data, according to a BCBS spokesman.

So while this trend may seem promising for providers, the sample size is small. As of September, only 26,794 people had enrolled in new insurance plans via the federal exchange. Only 992 of those people were in Tennessee.

Still, Paulk said, the subsidies offered to people who purchase plans on the exchange are effective — they make those silver plans affordable.

For another matter, features of insurance plans that providers thought would baffle consumers actually don’t.

A factor that providers may not have considered is that just because people didn’t have insurance recently doesn’t mean they never did. “It feels like a lot of people just make a broad assumption that the uninsured have always been uninsured,” said Paulk, “but people move in and out of categories.”

In other words, the numbers are early, but there’s evidence that the insurance purchasing public is, perhaps, more sophisticated than providers thought.